Federal and state lawmakers are seeking policy solutions to address the child care crisis that was exacerbated by the pandemic. Workforce challenges loom large, with necessary attention to boost wages for the child care professionals who play a role in not only helping parents work, but also promoting early childhood development. But states can also support child care workers by taking steps to ensure they have access to affordable health care coverage.

Today, CLASP, CCF, and BUILD are releasing a brief outlining ways states can ensure more child care professionals access to affordable health coverage. Consistent health coverage plays an important role in helping to stabilize the child care workforce by minimizing health and financial risks that translate to missed days and turnover.

In 2019, 16 percent of child care workers under age 65 were uninsured, compared to 13.3 percent of all adults under 65, reflecting a historic undervaluation of a workforce dominated by women, especially women of color. In states that haven’t expanded Medicaid to low-income adults, child care workers are nearly three times more likely to be uninsured (30.6%) than their peers in states that have expanded Medicaid (10.3%). While many national and state efforts have looked to address child care wages, D.C., Washington, and other states highlighted in the paper have sought to do more to help child care workers maintain access to affordable health insurance as wages rise.

What more can states do to help ensure child care workers have access to affordable health care coverage?

• Expand Medicaid. The recent election saw expansion adopted in South Dakota, now leaving 11 states that have yet to expand Medicaid to low-wage adults. Doing so would close a coverage gap that excludes many child care workers in both professional centers as well as family child care homes.
• Boost outreach and enrollment assistance. Washington state found out that tailored outreach and enrollment assistance helped 5,000 uninsured child care workers gain access to Medicaid or marketplace coverage. Recent federal improvements in federal subsidies for marketplace plans have made coverage even more affordable for those who don’t qualify for Medicaid. But it’s important to note that many adults will qualify for Medicaid, which is open all year round for anyone that qualifies, making outreach and enrollment important for Medicaid outside of open enrollment periods.
• Make all state residents eligible for coverage. Federal law leaves many immigrants without access to affordable coverage. California and Colorado have opted to use state funds to close this gap.
• Improve Marketplace coverage affordability. States can also use state funds to add onto federal marketplace tax credits and supports that lower plan cost. Massachusetts took this step for residents up to 300% FPL, and D.C. used its new Early Childhood Educator Pay Equity Fund to eliminate most marketplace premiums on top of boosted wages in 2023.
• Reduce red tape in Medicaid. As we’ve seen with children, many adults eligible for Medicaid may not be enrolled because of red tape, leading to unnecessary churn. States can seek federal permission to extend eligibility periods for adults to 12 months (New York, Kansas) or longer (2 years in Oregon for ages 6 and older), minimizing burdensome paperwork and added stress for low-wage workers.

While each of these steps is important, targeted outreach during Marketplace open enrollment provides an immediate opportunity that requires urgent action as it closes on January 15 for 2023 plans (a December enrollment deadline ensures coverage will begin on January 1, 2023). To this end, HHS agencies have been working together to create tools and materials to help spread the word, such as:

• A December 7^th webinar on health coverage for early childhood educators, where participants will learn about health insurance enrollment via a train-the-trainer demonstration and CMS’s upcoming Week of Action for Early Childhood Educators (January 8-15).
• Partner toolkits and resources, including talking points and the opportunity for individuals or organizations to become a Champion for Coverage.

The strategies for supporting uninsured child care professionals are no different than for other low-income workers.  The child care workforce crisis brings the need for improved health coverage for low-income workers into sharper focus.